Attitude of Patients With Physical Illness To Psychiatric Referral: Case Series of twelve Patients

Abstract

Aim: Both physicians and patients react with mixed feelings when the opinion of a psychiatrist is needed. It is more acceptable to have a medical or surgical problem than to have a mental problem. Many patients are reluctant to accept that their somatic symptoms may have psychological causes and that referral to a psychiatrist may be appropriate. This report is on the outcome of in-patient and out-patient follow-up management of 12 patients with the aim of exploring their attitude to mental illness.

Materials and Methods: a case series of 12 patients with psychiatric co-morbidity referred by other specialists, seen and managed to the point they were mentally stable in a consultation- liaison unit of the department of Behavioural Sciences,University of Ilorin Teaching Hospital,Nigeria. Patients were interviewed using a standardized diagnostic interview schedule- the PSE. Data were also collected on their demographic variables. Patients were followed up prospectively in the out patient clinic for 3 months after discharge.

Results: The average age of the 12 patient (±SD) was 35.8±19.3 years. Seven (58.3%) were married while 5 (41.7%) were single. More than half (58.3%) of the referral came from internal medicine department. Majority (91.7%) had no past psychiatric history and the commonest psychiatric diagnosis was acute organic brain syndrome. Six (50%) of the patients out rightly defaulted follow-up.

Conclusion: The high default rate recorded in this study is indicative of a negative attitude on the part of patients to being referred to a psychiatrist. Factors responsible for this negative attitude include the fear of being stigmatized and preference for traditional mental heath practitioners who share the same aetiological concept with them. More effort in increasing public awareness and education about mental illness to reduce stigma is recommended. Consultation –liaison psychiatric services could also be incorporated into the outpatient services of other non psychiatric specialties so that such patients could be seen by mental health professional where patients with physical illnesses are being attended to. There is also the need for increase collaboration with traditional mental heath practitioner to facilitate continuity of care for defaulting patients.